- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $4,955.00 / $4,955.00
| Facility | | $1,100.00 | $4,955.00 | $4,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,799.28 / $5,266.29 / $7,095.63
| Facility | | $1,799.28 | $5,266.29 | $7,095.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.86 / $707.00 / $2,626.50
| Facility | | $407.86 | $707.00 | $2,626.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $525.00 / $10,000.00
| Facility | | $400.00 | $525.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $500.00 / $1,149.00
| Facility | | $358.00 | $500.00 | $1,149.00 |